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Eur J Cardiothorac Surg. 2019 Jun 1;55(6):1180-1186. doi: 10.1093/ejcts/ezy414.

The Ross procedure versus mechanical aortic valve replacement in young patients: a decision analysis.

Author information

1
Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
2
Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
3
Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.

Abstract

OBJECTIVES:

Our goal was to determine the range of perioperative mortality rates associated with the Ross procedure that results in a life expectancy similar to that seen with mechanical aortic valve replacement (mAVR) in young patients with aortic valve disease.

METHODS:

A fully probabilistic Markov microsimulation model with 1000 outer loops and 10 000 inner loops was constructed to compare gain in life expectancy and quality-adjusted life years between the index treatment with the Ross procedure versus mAVR for a theoretical cohort of young patients with aortic valve disease. Inputs for early deaths and late complications (death, stroke, bleeding, reoperation) were obtained from a single-centre study of 208 propensity score matched patients. In the primary analysis, the perioperative mortality rate for the Ross procedure was varied by increments of 0.5% to determine its impact on life expectancy and quality-adjusted life years. A 2-way sensitivity analysis was conducted to determine simultaneously the impact of the Ross reoperation rate and Ross reoperative mortality rate on life expectancy.

RESULTS:

Life expectancy was improved with the Ross procedure when the perioperative mortality rate with the Ross procedure was <2.5% and was equivalent to mAVR when the mortality rate was 2.5% to 5%. Similarly, when the perioperative mortality rate of the Ross procedure was between 4% and 5.5%, the quality-adjusted life years gained were similar between the Ross procedure and mAVR. Life expectancy was improved when the Ross procedure reoperative mortality rate was <7% at an incidence of Ross reoperations of 18% at 20 years.

CONCLUSIONS:

Improved life expectancy can be expected with the Ross procedure when the operative mortality rate is less than 2.5%.

KEYWORDS:

Aortic valve; Aortic valve replacement; Decision analysis; Ross

PMID:
30535102
DOI:
10.1093/ejcts/ezy414

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